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By most accounts, Sarah lives a normal life. Twice a day, Sarah also walks down the street from her apartment to a clinic where she takes a treatment to stabilize her chronic disease. Sarah is one of 1, people who are part of a heroin-assisted treatment HAT program in Switzerland. One of those four pillars includes new and expanded treatment options for opioid users, including heroin-assisted treatment. The heroin provision was the most controversial part of the multi-prong Swiss drug policy. The Swiss, in keeping with their national stereotype, kept meticulous records. They found data to support the program through years of scientific study and strict randomized controlled trials before incorporating HAT into the law. Since then, the number of new heroin users in Switzerland has declined. Drug overdose deaths dropped by 64 percent. HIV infections dropped by 84 percent. Home thefts dropped by 98 percent. And the Swiss prosecute 75 percent fewer opioid-related drug cases each year. Meanwhile, in the United States, drug overdoses kill more Americans than car crashes, according to the Centers for Disease Control and Prevention. The number of overdose deaths in North Carolina went up in , and an average of four people overdose and die each day. The Swiss law requires that HAT patients must have at least two years of opioid dependence before starting treatment. They must have tried and failed two other addiction treatments and be at least 18 years old. The program was designed to treat the small percentage of people with substance use disorder who do not benefit from more traditional opioid substitution therapies, such as oral methadone or buprenorphine. Another substance being used to pad street drugs in Switzerland is an animal dewormer. In , more than 1, overdose deaths in North Carolina involved fentanyl, which is often cut into heroin or other street drugs. It also frees up the time previously spent finding the street product, enabling users to focus on things like housing, family and employment. There are hardly any young newcomers. When HAT programs started, 85 percent of participants were younger than Today, 80 percent are over the age of As the sun set outside, an increased flow of people arrived at the clinic for their second daily dose of heroin. They were polite, but not interested in making small talk in the waiting area outside the injection room. In Geneva, patients only have two time frames — the morning and the evening — to get their treatment. An older woman named Flor agreed to a short interview as she waited. Here, it helps me to have another life and do other things. When she was young, she studied theater in school. Now, Flor says she been able to get back into acting. The program also gives her peace of mind, because unlike in the streets, the product is always the same, she said. Sarah, the English woman, came in after Flor, looking equally jittery. Her eyes appeared slightly glazed, but she was more upbeat and ready to walk with her dog to a cafe across the street and chat with a reporter. Over coffee she explained her erratic journey with drugs — both heroin and cocaine — and how she found stability and comfort in the HAT program. Sarah tried heroin for the first time at age 18 but said it was too expensive. Her heroin use became consistent in the late s, when she was in her 30s and heroin was cheap. For the first six months, she used heroin off and on. For the next five years, she divided up her weekly stash into daily packets and managed to keep her full-time job and care for her small children. So she went to rehab and stayed four months. She tried rehab again, this time for a whole year. Sarah says she was lucky to have supportive friends, family and an apartment to come back to after. She found another job, but after a few months went back to using. Sarah set boundaries and rules for herself while using heroin. She would not use at work or in a public bathroom. Instead, she used the drug consumption room during her lunch break. But all the self-discipline went away with cocaine. But had I spent another two months on the street, that would have been it. And if I had done that, I felt like I could never get up again. She said it acts as an antidepressant for her. She frequently goes back to England to visit her mother for holidays and takes oral morphine instead. The randomized controlled trials included 1, participants in 17 places, including new and existing opioid substitution clinics and prisons across Switzerland. The European Monitoring Centre review found some promising trends. HAT program participants use less street heroin and illegal drugs than in the control groups treated with oral methadone. The annual cost per HAT patient ranges from 12, euros a year in Switzerland to 20, euros in the Netherlands. These are much higher than the annual cost of oral methadone treatment, which is 3, euros per patient in Germany and 1, a person in the Netherlands. The increased cost is due to the high staffing need at heroin treatment facilities. Most HAT programs require multiple staff members present at all times. And most programs do not allow the same take-home dosages allowed with other opioid substitution programs. So clinics must be open days a year for extended morning and evening hours. However, Switzerland changed the law in to allow two days of oral heroin take-home doses for stabilized patients. The European Monitoring Centre determined that HAT programs result in significant savings to society, particularly in the reduction of costs from criminal justice proceedings and incarceration of drug users. Beck, the medical director of the heroin-assisted treatment program in Zurich, said that when he goes to conferences in North America, his U. There will always be moral objection to these kinds of programs, Beck said. There are people in Switzerland who hear all the evidence and data for HAT but will not support it. Rita Annoni Manghi, medical director of the the HAT program in Geneva, said she, her colleagues and patients met with community members at coffee shops to explain what they were doing. Neighbors around the HAT facility were scared of the program and thought it would lead to more drug use, she said. This work is very important to change the minds of people. So these countries created spaces for them. Republish This Story. Taylor Knopf writes about mental health, including addiction and harm reduction. Knopf has a bachelor's degree in sociology with a minor in journalism. Been trying to contact you to voice several issues having to do with different manifestations and problematic dynamics, all having to do with what appears to be an endless slew of government tactics that will never positively influence our horrific addiction epidemic and number of associated deaths. Sadly, those sanctioned to make a difference are few and operate exclusively from self-derived, ill-informed understanding. By continued reliance upon inexperienced paradigms, the collective closed mind of an empowered few will sustain or worsen the nightmare. Change will come from minds that become open to acknowledge and accept the truth, best-told by experienced addicts and their families. Yep, I fully agree with the sentiment that harm reduction has been overwhelmingly proven as the most sensible and effective treatment for long term chronic opiate addiction. Skip to content Read all of our joint coverage with The Charlotte Ledger here. Staff worker at the heroin-assisted treatment facility in Geneva prepares injectable heroin before the patients arrive. She has a substance use disorder, and her treatment includes injectable heroin. So it started supporting them. Thilo Beck, psychiatrist and medical director of the heroin assisted treatment facility in Zurich, holds a bottle of medical-grade heroin as patients go into the glass doors on the left to inject. Photo credit: Andy Specht. People walking to work one early November morning in Geneva, Switzerland. An injection space inside the heroin-assisted treatment facility in Geneva. Photo credit: Taylor Knopf. Republish our articles for free, online or in print, under a Creative Commons license. Taylor Knopf. Next Proposed rule would require licensed daycares to test for lead in their water. Excellent article, thanks for expanding our vision of new treatments to try. This is excellent reporting on important steps being taken elsewhere. Thank you, Ms Knopf. 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Switzerland’s alarming crack epidemic

Geneve buying Heroin

Since , Switzerland has experienced a flood of concentrated and cheap cocaine, part of which is sold as crack. People can be seen openly taking drugs in several cantons, with Geneva the hardest hit. This time cocaine is driving consumption. The white powder is flooding European cities and supplanting heroin. The cocaine-based product is smoked with a glass pipe and gives a powerful high. Although the drug has been consumed in Switzerland for years, its availability has exploded. The explosion in crack consumption is particularly high in Geneva, where it is sold ready for consumption by dealers of African origin coming from France. Crack users once bought cocaine in the street and bicarbonate of soda at Migros, before cooking the drug at home. The discounted crack has increased the pace of consumption. Every day, dozens of smokers gather around Quai 9, a secure centre for addicts in Geneva beside Cornavin station. Since then, the smoking room has been out of bounds to crack users, except for those who come to sleep in one of the 12 camp beds at Quai 9. This came as a shock, acknowledges Pascal Dupont, manager of Entracte, a daycare centre for drug addicts in Geneva. This epidemic is shaking the foundations of the support structures. Users stop eating, drinking and even sleeping. Their condition shocks people and they lose touch with their friends and acquaintances. He has seen some of his regulars cut their ties with the centre. Sometimes it takes a hospital visit before they start to think about getting off the drugs. Quai 9 will be expanded and have more staff. Users will have more night shelters to choose from. The idea is to offer addicts, some of whom receive no social welfare, places where they can have a break. Some of these people have no access to social welfare, such as users from France or the homeless in Geneva, who include those from a migration background. Elsewhere in Switzerland, crack is usually cooked by the user and sometimes a portion of it is sold on. Psychotropic drug users take more medicine there than elsewhere. The canton has already witnessed the early stages of the drug and has set up a dedicated working group in response. The popularity of crack in Switzerland may be partly due to precarious circumstances. Some of the people are already familiar with the drug or are on replacement medication and susceptible to relapse. What prospects have they got? In Geneva, the Quai 9 social workers bring bottles of water and food to the exhausted users taken in from the street. Emergency shelters offer respite and there are places that will take in crack users regardless of their condition, but the usual thresholds — minimum stay for example — are sometimes too high for these unstable people. The authorities in Zurich, Berne and Lausanne are also looking into the regulated sale of cocaine. 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Geneve buying Heroin